| NPI | 1720503915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-05419) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 11-05419) |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2021-12-08 |