| NPI | 1699855981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0016742) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT33609) |
| 225100000X Physical Therapist (Licence: FL PT 22916) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2023-01-06 |