| NPI | 1114054293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-1516) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 01543) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2007-07-08 |