| NPI | 1740497528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1104115) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1157133) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-02-27 |