| NPI | 1114397312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5233) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2015) |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2016-09-28 |