| NPI | 1659474997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: KS 11-03276) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: KS 11-03276) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2011-06-22 |