| NPI | 1710182464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 1793) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT-302) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2016-06-17 |