| NPI | 1285010199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PT0014394) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT4229) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2019-04-04 |