| NPI | 1316016082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 2909) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: OR 2909) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: OR 2909) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2009-12-01 |