| NPI | 1629142633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-01558) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2004016686) |
| 225100000X Physical Therapist (Licence: NE 966) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2015-03-18 |