| NPI | 1316415631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 6009) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27247) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2021-08-04 |