| NPI | 1487978961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1103540) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 1999143390) |
| 225100000X Physical Therapist (Licence: CA PT22735) | |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2010-03-26 |