| NPI | 1962154864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP031878T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 22025) |
| Enumeration Date | 2022-01-21 |
| Last Update Date | 2024-07-03 |