| NPI | 1669987079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5311) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OK 5311) |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2022-12-05 |