| NPI | 1942898028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP0369TT1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA CP032830T) |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2024-12-01 |