| NPI | 1124008180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0006781) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305205880) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2019-08-20 |