| NPI | 1164630265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1103448) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2004017077) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2014-07-10 |