| NPI | 1447805296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: KS 11-06282) |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2022-03-07 |