| NPI | 1619205127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0013587) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT020285) |
| Enumeration Date | 2009-11-20 |
| Last Update Date | 2016-01-29 |