| NPI | 1700807724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY 910) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 8780) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2020-04-22 |