| NPI | 1669817359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1104666) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2020010998) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2021-12-08 |