| NPI | 1295511194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019706) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3131934) |
| Enumeration Date | 2023-09-06 |
| Last Update Date | 2024-04-26 |