| NPI | 1316596422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME 6942) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 16633) |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2025-09-29 |