| NPI | 1770736829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 22997) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 9508) |
| Enumeration Date | 2008-11-02 |
| Last Update Date | 2019-08-08 |