| NPI | 1154936664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 203463) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1335669) |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2020-09-11 |