| NPI | 1669870424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0016601) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.021095) |
| Enumeration Date | 2014-12-10 |
| Last Update Date | 2020-03-09 |