| NPI | 1568948131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTLP.0000134) |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2018-07-16 |