| NPI | 1295169506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO MSPTL.000031) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213336) |
| Enumeration Date | 2013-08-23 |
| Last Update Date | 2025-05-20 |