| NPI | 1952008401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR CP018232T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1373739) |
| Enumeration Date | 2023-02-14 |
| Last Update Date | 2023-05-12 |