| NPI | 1699256990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63456) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27164) |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2023-04-21 |