| NPI | 1275786642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4574) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11018) |
| 225100000X Physical Therapist (Licence: TX 1152378) | |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2021-08-25 |