| NPI | 1811723216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS T-06213) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2024044686) |
| 225100000X Physical Therapist (Licence: MO 2024038708) | |
| 225100000X Physical Therapist (Licence: KS 11-07758) | |
| Enumeration Date | 2024-09-11 |
| Last Update Date | 2024-11-15 |