| NPI | 1922155134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.8790) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 8790) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2021-11-10 |