| NPI | 1942832803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP017621T) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: DE J1-0004181) | |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2023-01-19 |