| NPI | 1063073609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63345) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 4697) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2025-11-24 |