| NPI | 1407084676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4994) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3107756) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2025-06-19 |