| NPI | 1992249866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 16484) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041136-1) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2019-10-09 |