| NPI | 1215453188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0015105) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT32970) |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2020-04-01 |