| NPI | 1053274936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 66067) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0020992) |
| Enumeration Date | 2025-12-08 |
| Last Update Date | 2026-05-08 |