| NPI | 1801886494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-03227) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2002019592) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2018-03-17 |