| NPI | 1013527746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR CP049401T) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist | |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2025-09-15 |