| NPI | 1629181748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 4366) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 7649) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2020-11-24 |