| NPI | 1588710362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0014383) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 7759) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2016-11-17 |