| NPI | 1326733965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0021237) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME 6479) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2026-05-16 |