| NPI | 1154875540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-02913) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2023010743) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2023-11-29 |