| NPI | 1366943359 |
|---|---|
| Former Name | RUBEN BANUELOS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296749) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0015442) |
| Enumeration Date | 2018-02-24 |
| Last Update Date | 2023-07-06 |