| NPI | 1194394528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020536) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2021033700) |
| 225100000X Physical Therapist (Licence: TN 16293) | |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2025-05-26 |