| NPI | 1881940294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0012927) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT02503) |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2021-05-05 |