| NPI | 1073125563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020917) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT872659) |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2025-10-10 |