| NPI | 1821263864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 2099) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1101186) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2015-01-27 |