| NPI | 1275338204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP056207T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0015034) |
| 225100000X Physical Therapist | |
| 225100000X Physical Therapist (Licence: MD 30306) | |
| Enumeration Date | 2025-02-14 |
| Last Update Date | 2026-05-21 |