| NPI | 1992241368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0015207) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1265906) |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2021-03-31 |