| NPI | 1134964182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0019989) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 306205) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2024-07-26 |