| NPI | 1710465703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 18000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 09992) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2021-11-16 |