| NPI | 1053043414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 204614) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL0017484) |
| Enumeration Date | 2022-06-25 |
| Last Update Date | 2022-10-17 |