| NPI | 1487969911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1104724) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2019-12-18 |