| NPI | 1932616315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63553) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23355) |
| 225100000X Physical Therapist (Licence: CA 296846) | |
| Enumeration Date | 2018-01-06 |
| Last Update Date | 2023-07-10 |