| NPI | 1679014229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5337) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305210525) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2017-03-15 |