| NPI | 1225721319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 20240203) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: OK 6333) | |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2024-07-10 |