| NPI | 1699158741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27571) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT024401) |
| 225100000X Physical Therapist (Licence: OK 5553) | |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2025-11-04 |