| NPI | 1013173194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 5855) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2008020870) |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2018-04-05 |