| NPI | 1558515098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PT 11689) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 34971) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2016-06-23 |