| NPI | 1558779587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0013575) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4481) |
| 225100000X Physical Therapist (Licence: TN 9983) | |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2016-12-27 |