| NPI | 1629512322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0015432) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1283525) |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2018-02-27 |