| NPI | 1720009293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0016071) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT19898) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2020-12-04 |