| NPI | 1609856756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR CP061418T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 8118) |
| 225100000X Physical Therapist (Licence: OR 60017) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2026-08-20 |