| NPI | 1205155421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0015436) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1196561) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2024-12-10 |