| NPI | 1538590971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0017500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 40824) |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2022-09-19 |