| NPI | 1689193120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-32522) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 14518) |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2025-06-01 |