| NPI | 1295384931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-05985) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0015616) |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2021-06-10 |