| NPI | 1841660503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0014683) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY 1731) |
| 225100000X Physical Therapist (Licence: CA 42883) | |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2019-10-17 |