| NPI | 1285885590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1104965) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2006022069) |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2014-10-08 |