| NPI | 1245821099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OK 5043) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: OK 5043) | |
| Enumeration Date | 2021-02-02 |
| Last Update Date | 2021-02-02 |