| NPI | 1255949657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0016972) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 151773) |
| 225100000X Physical Therapist (Licence: AZ CP027231T) | |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2026-04-28 |