| NPI | 1821641317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212990) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP044588T) |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2025-06-24 |