| NPI | 1679802060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1189009) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP003045T) |
| 225100000X Physical Therapist (Licence: CO CP002476T) | |
| Enumeration Date | 2009-12-14 |
| Last Update Date | 2021-07-27 |