| NPI | 1417993411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP056453T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0001760) |
| 225100000X Physical Therapist (Licence: MD 20794) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2026-05-21 |