| NPI | 1144913948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP049966T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 237594) |
| 225100000X Physical Therapist (Licence: SC CP055318T) | |
| 225100000X Physical Therapist (Licence: TX 1377027) | |
| Enumeration Date | 2023-05-30 |
| Last Update Date | 2026-04-28 |