NPI | 1770791972 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1104036) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 109150) |
2251S0007X Physical Therapist, Sports (Licence: KS 1104036) | |
Enumeration Date | 2007-05-19 |
Last Update Date | 2011-12-30 |