| NPI | 1679822142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5273) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT3490) |
| 225100000X Physical Therapist (Licence: MD 24313) | |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2023-01-04 |