| NPI | 1922241322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 10543) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 35383) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2020-07-14 |