| NPI | 1619921137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-00821) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO R0956) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2021-06-16 |