NPI | 1538310529 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: KS 11-04083) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2009023899) |
Enumeration Date | 2008-10-08 |
Last Update Date | 2020-09-08 |