| NPI | 1205364460 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-06515) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2017020722) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2020-07-22 |