| NPI | 1821073883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4706) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 0400003482) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2015-01-05 |