| NPI | 1346076718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0020517) |
| Enumeration Date | 2024-09-11 |
| Last Update Date | 2025-06-17 |