| NPI | 1770360778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-07422) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 65939) |
| Enumeration Date | 2023-09-12 |
| Last Update Date | 2025-11-25 |