| NPI | 1417502790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 124657) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1301719) |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2023-12-04 |