| NPI | 1790767630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-03920) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT1461) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2012-11-16 |