| NPI | 1275146193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 18286) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT028886) |
| Enumeration Date | 2020-08-29 |
| Last Update Date | 2022-05-10 |