| NPI | 1689054678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-05068) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2015020034) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2023-10-09 |