| NPI | 1285459909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 21359) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1402799) |
| Enumeration Date | 2024-11-18 |
| Last Update Date | 2026-06-29 |