| NPI | 1174137897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018489) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT31915) |
| 225100000X Physical Therapist (Licence: VA 2305213872) | |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2024-01-09 |