| NPI | 1346403300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 10480) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 11015) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2020-07-07 |