| NPI | 1720787773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0019213) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11768) |
| Enumeration Date | 2023-02-28 |
| Last Update Date | 2023-07-12 |