| NPI | 1215665153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 19009) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH10968) |
| 225100000X Physical Therapist (Licence: TN 15339) | |
| Enumeration Date | 2022-08-09 |
| Last Update Date | 2023-11-14 |