| NPI | 1619421591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63239) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT025539) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2019-09-19 |