| NPI | 1346488467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0014229) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT30302) |
| Enumeration Date | 2009-01-27 |
| Last Update Date | 2020-03-27 |