| NPI | 1538545579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0015775) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1261313) |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2023-11-13 |