| NPI | 1043919608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020668) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA PTL26654) |
| Enumeration Date | 2023-03-02 |
| Last Update Date | 2025-06-23 |