| NPI | 1770876534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1104431) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MD 23700) |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2014-06-02 |