| NPI | 1013609304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-034695) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0019109) |
| Enumeration Date | 2023-05-24 |
| Last Update Date | 2026-03-05 |