| NPI | 1619971124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1102759) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 2223) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2010-09-22 |