| NPI | 1699296715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5242) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: TX CP029976T) | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2025-04-23 |