| NPI | 1346296423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 2261) |
| Additional Taxonomies | 225XH1200X Occupational Therapist, Hand (Licence: OK 1011100613) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2007-07-08 |