| NPI | 1689670812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-03577) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE CP052861T) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2026-02-02 |