| NPI | 1265209613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-07551) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS T-06065) |
| Enumeration Date | 2023-12-06 |
| Last Update Date | 2024-02-12 |