| NPI | 1558815225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61867) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 22642) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2021-03-20 |