| NPI | 1043413859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0010633) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029375) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2022-09-29 |