| NPI | 1649514704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-03478) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 3947) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2016-12-04 |