| NPI | 1215874078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP056167T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05014990A) |
| 225100000X Physical Therapist (Licence: AZ CP052541T) | |
| Enumeration Date | 2026-04-30 |
| Last Update Date | 2026-05-19 |