| NPI | 1750744777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-05316) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2016026109) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2016-10-05 |