| NPI | 1205087129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 2265) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2265) |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2026-05-19 |