| NPI | 1508498932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0017251) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0004172) |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2020-11-30 |