| NPI | 1720176951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 5471) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2058) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2014-03-06 |