| NPI | 1285010546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 00201156) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9992) |
| Enumeration Date | 2015-08-09 |
| Last Update Date | 2024-11-18 |