| NPI | 1598402844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215122) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP018405T) |
| 225100000X Physical Therapist (Licence: CO PTL.0015450) | |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2024-12-09 |