| NPI | 1184696205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR OR 60095) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 1612) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2016-04-22 |