| NPI | 1366491755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 9520) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 3047) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2021-05-20 |