| NPI | 1154367852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-02927) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2000170991) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2010-12-15 |