| NPI | 1750965315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-06784) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: KS T-05496) | |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2022-10-24 |