| NPI | 1447829478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-06764) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 15572-24) |
| 225100000X Physical Therapist (Licence: MO CP052634T) | |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2026-06-17 |