| NPI | 1871926014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 14498) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 14009863) |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2018-09-20 |