| NPI | 1205013760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH8714) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0011735) |
| 225100000X Physical Therapist (Licence: MO 1848) | |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2018-06-14 |