| NPI | 1437383437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-03966) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2014008564) |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2018-05-15 |