| NPI | 1104137751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1103824) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 0012597) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2020-09-29 |