| NPI | 1043508328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 12923) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 4502) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2022-07-21 |