| NPI | 1508919184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0016101) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 2480) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2022-01-28 |