| NPI | 1922297613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: CO 0011340) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0011340) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2024-05-16 |