| NPI | 1154706869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 9463254-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0013334) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2021-11-12 |