| NPI | 1124638473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 19750) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT37917) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2020-08-02 |
| Last Update Date | 2026-06-29 |