| NPI | 1881978278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-06343) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2015043540) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2019-12-10 |