| NPI | 1730467861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 6621) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 06621) |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2026-02-18 |