NPI | 1154736676 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: OR OR 60932) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO PTL.0012686) |
Enumeration Date | 2014-06-23 |
Last Update Date | 2015-07-16 |