| NPI | 1407592827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP039514T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 306387) |
| 225100000X Physical Therapist (Licence: NY 048215-01) | |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2025-01-22 |