| NPI | 1124449137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-04680) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT28919) |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2026-05-15 |