| NPI | 1750726923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 12237) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 40066) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2014-10-17 |