| NPI | 1851929327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0017264) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 099301) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2021-06-11 |