| NPI | 1336864388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 6564) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT5200) |
| Enumeration Date | 2022-10-11 |
| Last Update Date | 2026-04-15 |