| NPI | 1598367658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23999) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0019965) |
| 225100000X Physical Therapist (Licence: CA 301424) | |
| Enumeration Date | 2020-11-13 |
| Last Update Date | 2025-04-22 |