| NPI | 1588011555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305210216) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0014149) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2020-08-30 |