| NPI | 1891077053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0012590) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 06615) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2022-10-14 |