| NPI | 1851683221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 6791) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OK 1423) |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2026-01-21 |