| NPI | 1154096659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP011133T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 008347) |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2023-11-30 |