| NPI | 1184298432 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP044297T) | 
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214310) | 
| 225100000X Physical Therapist (Licence: AZ CP042420T) | |
| Enumeration Date | 2021-05-19 | 
| Last Update Date | 2025-06-09 |