| NPI | 1134608482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018190) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT33914) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2022-05-10 |