| NPI | 1205121076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16166) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 11190) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2023-05-23 |