| NPI | 1073872925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 2350) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 11046) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2012-05-14 |