| NPI | 1285072074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-3213) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2002025838) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2022-10-07 |