| NPI | 1851975783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-06806) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS T-05515) |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2021-09-14 |