| NPI | 1801343280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0017927) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT1658) |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2021-12-30 |