| NPI | 1861046963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0017136) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 20179026222) |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2020-09-23 |