| NPI | 1477723658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1104003) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10770-024) |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2021-08-23 |