| NPI | 1730667080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61071) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 61071) |
| 2251S0007X Physical Therapist, Sports (Licence: OR 61071) | |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2023-06-09 |