| NPI | 1114655636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 64561) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 64561) |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2023-04-26 |