| NPI | 1184285991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0013705) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT296573) |
| Enumeration Date | 2019-06-23 |
| Last Update Date | 2019-12-07 |