| NPI | 1114577871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 007710) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP007813T) |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2021-11-24 |