| NPI | 1861628331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 05964) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5964) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2017-03-17 |