| NPI | 1427489673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: KS 14-02534) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-02266) |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2022-07-21 |