| NPI | 1528712114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 64803) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT030181) |
| Enumeration Date | 2022-02-11 |
| Last Update Date | 2023-12-18 |