| NPI | 1609028844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0015273) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT-0938) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2018-12-19 |