| NPI | 1124719299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist Neurology (Licence: OR 64942) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 64942) |
| Enumeration Date | 2023-05-18 |
| Last Update Date | 2023-05-18 |