| NPI | 1760882609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0013150) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21237) |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2015-12-02 |