| NPI | 1548831399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP033607T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 31834) |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2024-11-08 |