| 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 |