| NPI | 1952301756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-03205) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2002029465) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2022-10-06 |