| NPI | 1497447320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP027926T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA CP022054T) |
| 225100000X Physical Therapist (Licence: TX 1373921) | |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2024-02-20 |