| NPI | 1093229106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0017111) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP050670T) |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2025-10-30 |