| NPI | 1114904083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1101792) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 01968) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2021-10-04 |