| NPI | 1891305785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019199) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT028545) |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2024-07-05 |