| NPI | 1427741297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP044558T) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 3131046) |
| Enumeration Date | 2023-05-30 |
| Last Update Date | 2025-05-30 |