| NPI | 1558747089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0017110) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 11701) |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2020-08-19 |