| NPI | 1689672727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OK PT2090) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: OK AT172) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2008-12-23 |