| NPI | 1972287902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP037019T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT016630) |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2024-12-12 |