| NPI | 1386433589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-07664) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 4615) |
| Enumeration Date | 2025-05-05 |
| Last Update Date | 2025-05-05 |