| NPI | 1093129033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4835) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM PT5719) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2020-12-18 |