| NPI | 1760769392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0011421) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 11421) |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2018-10-18 |