| NPI | 1497695399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020938) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 4669) |
| Enumeration Date | 2026-03-30 |
| Last Update Date | 2026-05-05 |