| NPI | 1306619929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP033008T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 051144) |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2024-08-20 |