| NPI | 1003412446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP039794T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR CP058712T) |
| 225100000X Physical Therapist (Licence: OH PT020170) | |
| Enumeration Date | 2020-12-10 |
| Last Update Date | 2026-06-17 |