| NPI | 1902451735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 17606) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1322378) |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2021-06-09 |