| NPI | 1477164416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0017362) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT36176) |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2020-11-09 |