| NPI | 1295970507 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4773) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OR 110302125) |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2008-12-16 |