| NPI | 1538398383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4536) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 24784) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2021-12-28 |