| NPI | 1225625171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019832) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 12325024) |
| Enumeration Date | 2020-12-27 |
| Last Update Date | 2024-05-22 |