| NPI | 1306137716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0008735) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 8735) |
| 225100000X Physical Therapist (Licence: DE J1-0002687) | |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2022-11-23 |