| NPI | 1326555350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1295130) |
| 225100000X Physical Therapist (Licence: AZ 13500) | |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2017-12-29 |