| NPI | 1134608144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: OR 61681) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: OR 61681) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2018-08-09 |