| NPI | 1609611532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP044824T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-033622) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2025-06-10 |