| NPI | 1154813673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0015663) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE CP043833T) |
| 225100000X Physical Therapist (Licence: OR CP048700T) | |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2026-06-11 |