| NPI | 1972762714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1101441) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO R1062) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2008-06-06 |