| NPI | 1306222799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 115430) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1262136) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2022-11-01 |