| NPI | 1225776081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2022028796) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 20110) |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2024-09-17 |