| NPI | 1740874601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0018159) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT36644) |
| Enumeration Date | 2021-02-22 |
| Last Update Date | 2022-03-02 |