| NPI | 1679142152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 2518) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 2518) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2025-07-10 |