| NPI | 1689233694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0016730) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM PT4784) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2020-01-17 |