| NPI | 1891731071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 2032) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK PT3832) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2008-07-08 |