| NPI | 1962930222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5331) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 4258) |
| 225100000X Physical Therapist (Licence: NM 5061) | |
| 225100000X Physical Therapist (Licence: UT 7275450-2401) | |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2021-09-27 |