| NPI | 1740972405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP022082T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 2582) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2025-02-22 |