| NPI | 1114362852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0007673) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5359) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2023-04-06 |