| NPI | 1720111529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-31513) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 7483) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2024-12-31 |