| NPI | 1144601089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0019831) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 21655) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2024-05-30 |