| NPI | 1346079050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK CP038483T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2024026243) |
| Enumeration Date | 2024-07-31 |
| Last Update Date | 2024-12-20 |