| NPI | 1811971880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4175) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1106995) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2013-06-26 |