| NPI | 1801397880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0017565) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT025956) |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2021-11-19 |