| NPI | 1194925115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4093) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: OK 4093) |
| 2251S0007X Physical Therapist Sports (Licence: OK 4093) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: OK 4093) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2024-04-06 |