| NPI | 1952640872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0013062) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 27877) |
| Enumeration Date | 2013-02-13 |
| Last Update Date | 2021-07-20 |