| NPI | 1821275454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 6854) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 3417) |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2016-07-21 |