| NPI | 1023857547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 20732) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT7723) |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2025-08-06 |