| NPI | 1780763219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0015495) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 6382) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2024-11-25 |