| NPI | 1205111259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1106411) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004778) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2024-01-29 |