| NPI | 1639700933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63387) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 63887) |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2020-01-27 |