| NPI | 1053728501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 6639) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003336) |
| 225100000X Physical Therapist (Licence: OR 60527) | |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2019-06-18 |