| NPI | 1114306941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-31604) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0013279) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2021-03-04 |