| NPI | 1316523228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 19809) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28361) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2024-07-09 |