| NPI | 1205575925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018090) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0018090) |
| 225100000X Physical Therapist (Licence: NM PT6080) | |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2024-01-05 |