| NPI | 1184361396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP048775T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 32363) |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2025-10-09 |