| NPI | 1295560100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 20757) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501303478) |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2025-08-05 |