| NPI | 1194583476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS CP-05470-2) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2024009422) |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2026-04-17 |