| NPI | 1548971427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019039) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT37451) |
| Enumeration Date | 2022-12-12 |
| Last Update Date | 2023-05-30 |