| NPI | 1053501437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4021) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1197631) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2014-10-27 |