| NPI | 1457880478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-05745) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS T04718) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2020-01-23 |