| NPI | 1124494091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 16604) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011997) |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2019-11-07 |