| NPI | 1710394267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-06637) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 24690) |
| 225100000X Physical Therapist (Licence: MD 25077) | |
| 225100000X Physical Therapist (Licence: MO 2020037408) | |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2020-11-10 |