| NPI | 1376878108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4288) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2009025549) |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2015-07-09 |