| NPI | 1548837917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P-CP011508T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 5982) |
| Enumeration Date | 2021-06-05 |
| Last Update Date | 2022-05-25 |