| NPI | 1578130381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0019066) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 4531) |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2023-11-21 |