| NPI | 1831602879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0016870) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26717) |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2022-09-29 |