| NPI | 1679092092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP011430T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0015163) |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2022-07-19 |