| NPI | 1235518846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0013275) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT1571) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2022-07-21 |