| NPI | 1952597809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 06831) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 6831) |
| 225100000X Physical Therapist (Licence: FL PT 17941) | |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2017-10-10 |