| NPI | 1902935877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK CP030028T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1130680) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1130680) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2024-05-21 |