| NPI | 1104033364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-02796) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 106098) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2007-07-08 |