| NPI | 1720696883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019996) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2024-08-20 |