| NPI | 1700062015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO CP004494T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-06384) |
| 225100000X Physical Therapist (Licence: CO 10971) | |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2021-09-10 |