| NPI | 1083974141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 115141) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: TN 13007) | |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2022-12-20 |