| NPI | 1801024237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5213) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5987) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2016-06-27 |