| NPI | 1538962923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020439) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP043632T) |
| Enumeration Date | 2025-03-31 |
| Last Update Date | 2025-04-17 |