| NPI | 1174773139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 10999) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 18409) |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2017-10-26 |