| NPI | 1679922462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK PT5162) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: OK 5162) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2019-07-16 |