| NPI | 1164945051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0016672) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 293255) |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2019-10-14 |