| NPI | 1255399325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 4197) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: OR 27 3291) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2008-05-22 |