| NPI | 1255289971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP054488T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0021203) |
| 225100000X Physical Therapist (Licence: NJ 40QA02397500) | |
| 225100000X Physical Therapist (Licence: SC CP060149T) | |
| Enumeration Date | 2026-03-18 |
| Last Update Date | 2026-08-03 |