| NPI | 1720255623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-02930) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 4166) |
| Enumeration Date | 2008-05-11 |
| Last Update Date | 2013-04-05 |