| NPI | 1669708491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 62408) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 16338) |
| Enumeration Date | 2009-10-29 |
| Last Update Date | 2022-07-21 |