| NPI | 1306676671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65703) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 5061379) |
| Enumeration Date | 2024-08-02 |
| Last Update Date | 2025-09-04 |