| NPI | 1164074852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: CO 0016393) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 0016393) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2019-07-12 |