| NPI | 1790932952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 05618) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5618) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2008-12-23 |