| NPI | 1437768306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63743) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: OR 63743) |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2020-08-11 |