| NPI | 1316069073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0013736) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT17788) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2019-11-01 |