| NPI | 1629128756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 00734) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 0734) |
| 225500000X Specialist/Technologist (Licence: OR AT 941024) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2008-02-06 |