NPI | 1356342661 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 5149) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 26238) |
2251X0800X Physical Therapist, Orthopedic (Licence: OR 5149) | |
Enumeration Date | 2005-08-09 |
Last Update Date | 2024-08-06 |