| NPI | 1205594165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP032538T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 10963) |
| 225100000X Physical Therapist (Licence: AZ 10963) | |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2024-07-10 |