| NPI | 1669028114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018069) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT029363) |
| 225100000X Physical Therapist (Licence: MA 24469) | |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2024-01-17 |