| NPI | 1992873574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-06311) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2002018265) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2025-03-03 |