| NPI | 1821624958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 403) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 661) |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2020-03-20 |