| NPI | 1962869131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0014643) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 11861) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2023-10-19 |