| NPI | 1902043557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5080) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT009447) |
| 225100000X Physical Therapist (Licence: LA 06529R) | |
| Enumeration Date | 2009-01-17 |
| Last Update Date | 2019-01-16 |