| 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 |