| NPI | 1225858194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-04993) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2001010967) |
| Enumeration Date | 2024-10-15 |
| Last Update Date | 2024-10-15 |