| NPI | 1003394800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020215) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT027006) |
| 225100000X Physical Therapist (Licence: SC 12575) | |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2025-10-28 |