| NPI | 1407967110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-03031) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE CP052945T) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2026-02-02 |