| NPI | 1245992650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 20665) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10901) |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2025-09-29 |