| NPI | 1396023776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1104311) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-04311) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2020-02-20 |