| NPI | 1609659986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 1836) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 1160) |
| Enumeration Date | 2023-08-18 |
| Last Update Date | 2023-08-18 |