| NPI | 1225036809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK CP001166T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1152227) |
| 225100000X Physical Therapist (Licence: AZ 3267) | |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2021-05-27 |