| NPI | 1588177935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5950) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1299021) |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2021-02-08 |