| NPI | 1316957145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1103375) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2014023790) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2014-08-27 |