| NPI | 1538667811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0016198) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 294325) |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2020-02-11 |