| NPI | 1255260576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP060318T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP056068T) |
| 225100000X Physical Therapist (Licence: VA 2305217065) | |
| Enumeration Date | 2026-05-14 |
| Last Update Date | 2026-08-05 |