| NPI | 1356743777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61486) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT022811) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2016-09-12 |