| NPI | 1861742520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-04553) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2012025600) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2015-07-01 |