| NPI | 1528209194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: OR 7848) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 4742) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2009-03-12 |