| NPI | 1013434539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0016639) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305211318) |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2020-08-17 |