| NPI | 1679023956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0014227) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT003630) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2016-10-10 |