| NPI | 1720447576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 19758) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 16140) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2024-03-28 |