| NPI | 1164712972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 16218) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1141570) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2023-10-03 |