| NPI | 1215912498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 5626) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PT 8290) |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2020-08-03 |