| NPI | 1811061443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 06679) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT 2187) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2016-07-22 |