| NPI | 1205242526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4897) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 10946) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2014-07-08 |