| NPI | 1871941849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5131) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OK 5131) |
| 171000000X Military Health Care Provider (Licence: OK 5131) | |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2025-02-19 |