| NPI | 1922656818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-06162) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2019021044) |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2026-04-22 |