| NPI | 1790453728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019924) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT015415) |
| 225100000X Physical Therapist (Licence: CO CP018446T) | |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2024-06-18 |