| NPI | 1336890870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019690) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: AZ 32177) |
| 225100000X Physical Therapist (Licence: AZ 32177) | |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2024-03-13 |