| NPI | 1659115392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-07775) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP032813T) |
| 225100000X Physical Therapist (Licence: SC CP032812T) | |
| 225100000X Physical Therapist (Licence: MO 2024021626) | |
| Enumeration Date | 2024-06-19 |
| Last Update Date | 2024-12-20 |