| NPI | 1649881632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-06911) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1336388) |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2021-10-25 |