| NPI | 1508243973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2014027110) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0013190) |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2019-02-07 |