| NPI | 1740841725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-06269) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1308610) |
| 225100000X Physical Therapist (Licence: MO 2019029583) | |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2019-08-15 |