| NPI | 1942688007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5937) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 8303) |
| 225100000X Physical Therapist (Licence: TX 1258439) | |
| Enumeration Date | 2015-05-09 |
| Last Update Date | 2023-03-11 |