| NPI | 1811589468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018535) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 5946) |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2022-12-07 |