| NPI | 1326026758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR OR4764) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 8230) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2024-05-13 |