| NPI | 1144827981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP048042T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16240-24) |
| 225100000X Physical Therapist (Licence: CA 229218) | |
| 225100000X Physical Therapist (Licence: TX 1381381) | |
| 225100000X Physical Therapist (Licence: AZ 033508) | |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2025-08-11 |