| NPI | 1982613493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-07456) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK PT1705) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2023-12-15 |