| NPI | 1770985566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-04929) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: KS 11-04929) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: KS 11-04929) | |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2025-06-18 |