| NPI | 1760017388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0016848) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0016848) |
| Enumeration Date | 2020-03-04 |
| Last Update Date | 2020-11-17 |