| NPI | 1679248967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019530) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 31913) |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2024-10-31 |