| NPI | 1346822210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP046403T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 4920) |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2025-07-28 |