| NPI | 1992982284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 3948) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 09302R) |
| 225100000X Physical Therapist (Licence: AR PT3595) | |
| 225100000X Physical Therapist (Licence: TN 9783) | |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2016-10-06 |