| NPI | 1871671107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 16135) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT008424) |
| 225100000X Physical Therapist (Licence: FL PT28160) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2019-06-19 |