| NPI | 1437601127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-07348) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P20529) |
| 225100000X Physical Therapist (Licence: MO 2022049182) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2023-12-28 |