| NPI | 1568129120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 19796) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT38077) |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2024-12-11 |