| NPI | 1063180214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 2564) |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2025-10-22 |