| NPI | 1437501822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-05339) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2018-05-19 |