| NPI | 1174758593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-03874) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5909) |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2021-05-21 |