| NPI | 1720765720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP035602T) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: CP035602T) | |
| Enumeration Date | 2023-06-30 |
| Last Update Date | 2024-10-31 |