| NPI | 1598120420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-06844) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2015027116) |
| Enumeration Date | 2015-12-18 |
| Last Update Date | 2021-12-03 |