| NPI | 1154805299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0015877) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT026987) |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2018-09-24 |