| NPI | 1326778788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020396) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM PT6133) |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2025-04-21 |