| NPI | 1346528148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0011847) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 9395) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2019-08-22 |