| NPI | 1841996048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018861) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0018861) |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2023-03-17 |