| NPI | 1336809268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 20805) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 048235) |
| Enumeration Date | 2021-12-20 |
| Last Update Date | 2025-10-01 |