| 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 |