| NPI | 1609585496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018976) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 303242) |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2025-04-08 |