| NPI | 1104593086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL19343) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT029637) |
| 225100000X Physical Therapist (Licence: DC PT210002254) | |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2024-12-11 |