| NPI | 1699229070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 15912) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2016023585) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2018-08-29 |