| NPI | 1386242048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP011054T) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 1336523) |
| 225100000X Physical Therapist | |
| 225100000X Physical Therapist (Licence: CA PT303969) | |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2025-03-06 |