| NPI | 1487177549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0015719) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 10411567-8016) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2018-10-30 |