| NPI | 1730148875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR OR-4795) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV NV-1312) |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2008-07-11 |