| NPI | 1982086260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0013390) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11105) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2020-10-02 |