| NPI | 1063242535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0021236) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT032627) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2026-06-10 |