| NPI | 1417587676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: OK 1-E-8553) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 5329) |
| Enumeration Date | 2020-01-16 |
| Last Update Date | 2024-09-24 |