| NPI | 1245121938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2025028627) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 21275) |
| Enumeration Date | 2025-07-11 |
| Last Update Date | 2026-06-10 |