| NPI | 1538465182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4404) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 2794) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2021-08-25 |