| NPI | 1912010265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 9933) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1105732) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2020-04-08 |