| NPI | 1487094470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0015449) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT5258) |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2018-07-29 |