| NPI | 1033127469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 21124) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL-9250) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2019-05-28 |