| NPI | 1558975938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0017706) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 63861) |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2022-01-26 |