| NPI | 1699144923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO PTL.0013704) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC PTL.0013704) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2024-01-17 |