| NPI | 1609810266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212509) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 11245) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-08-04 |