| NPI | 1649821232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0017405) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS CP000516T) |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2024-09-17 |