| NPI | 1760165062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 6430) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OK PT6430) |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2025-01-24 |