| NPI | 1154895506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 5437) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0015893) |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2021-04-27 |