| NPI | 1477224293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11006773) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2021032083) |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2023-08-29 |