| NPI | 1457091282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP010362T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT4804) |
| 225100000X Physical Therapist (Licence: NC P-CP011162T) | |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2022-07-25 |