| NPI | 1467117382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0019391) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-32068) |
| Enumeration Date | 2021-11-04 |
| Last Update Date | 2025-05-04 |