| NPI | 1801067079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0015793) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 3460) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2019-08-26 |