| NPI | 1790178341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP024622T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 7765) |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2024-01-22 |