| NPI | 1124788013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 19008) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 4729) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2021-12-20 |
| Last Update Date | 2024-08-01 |