| NPI | 1619381639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 16791) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 12649) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2020-07-27 |