| NPI | 1558245258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0021474) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2025033895) |
| Enumeration Date | 2025-08-05 |
| Last Update Date | 2026-09-11 |