| NPI | 1649519034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0014420) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 39908) |
| 225100000X Physical Therapist (Licence: OR 60505) | |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2017-11-09 |