| NPI | 1902386121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0016762) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 295270) |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2022-11-21 |