| NPI | 1386294510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5669) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-30504) |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2019-09-19 |