| NPI | 1417959248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63984) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 2043) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2024-07-22 |