| NPI | 1700956661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018816) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL PENDING) |
| 225100000X Physical Therapist (Licence: FL PT22983) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2023-04-12 |