| NPI | 1538253364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 06238) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: OR 06238) |
| 2251C2600X Physical Therapist, Cardiopulmonary (Licence: OR PT 06238) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-06-04 |