| NPI | 1528484425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0014105) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 41120) |
| Enumeration Date | 2014-03-15 |
| Last Update Date | 2020-03-26 |