| NPI | 1720507783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 16206) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23158) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2022-07-21 |