| NPI | 1336035112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 21122) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 4825) |
| Enumeration Date | 2025-06-17 |
| Last Update Date | 2026-06-04 |