| NPI | 1730856725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP017502T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214615) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2024-10-15 |