| NPI | 1184298432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP044297T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP042420T) |
| 225100000X Physical Therapist (Licence: VA 2305214310) | |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2026-07-14 |