| NPI | 1396844965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-02218) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 10809) |
| 225100000X Physical Therapist (Licence: CA 10284) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2024-04-20 |