| NPI | 1396152070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2017018557) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0012764) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2025-01-02 |