| NPI | 1023254695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 005964) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 9696) |
| Enumeration Date | 2008-12-31 |
| Last Update Date | 2019-06-26 |