| NPI | 1942843503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP000731T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP025628T) |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2023-10-20 |