| NPI | 1043404213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0009745) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 9745) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2022-03-08 |