| NPI | 1558842054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 62814) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR 62814) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2021-02-16 |