| NPI | 1790164416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0013315) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-06-02 |