| NPI | 1063921476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018839) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 2305211550) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2023-01-31 |