| NPI | 1164174975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019175) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: AZ 32190) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-01-23 |
| Last Update Date | 2023-07-09 |