| NPI | 1477809226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-04469) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2012025073) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2021-11-12 |