| NPI | 1881955490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-04227) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2008023533) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2012-05-31 |