| NPI | 1376825356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63856) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 11449) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2025-01-21 |