NPI | 1437693553 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5145) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: 53679) |
Enumeration Date | 2016-12-08 |
Last Update Date | 2020-03-09 |