| NPI | 1770983777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0013909) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 17983) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2020-12-14 |