| NPI | 1356958862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2022018258) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 10419) |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2026-03-06 |