| NPI | 1558899567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-05731) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: KS T-04726) |
| Enumeration Date | 2017-06-03 |
| Last Update Date | 2018-05-17 |