| NPI | 1730554908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61924) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0013646) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2016-10-20 |