| NPI | 1346014644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020539) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT032245) |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2025-05-06 |