| NPI | 1164573408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 13776) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305203572) |
| 225100000X Physical Therapist (Licence: GA PT009000) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2019-02-11 |