| NPI | 1699223115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018409) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 292072) |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2022-08-09 |