| NPI | 1881277093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-06121) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2019023330) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2022-05-28 |