| NPI | 1346008620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-034419) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0019691) |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2025-11-19 |