| NPI | 1265105456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0019055) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P24217) |
| 225100000X Physical Therapist (Licence: AL PTH11180) | |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2026-04-08 |