| NPI | 1447489729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL-10459) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0010459) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2024-05-16 |