| NPI | 1144895830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-06914) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 6040) |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-10-20 |