| NPI | 1083412043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP04291OT) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-29923) |
| Enumeration Date | 2025-03-05 |
| Last Update Date | 2025-03-12 |