| NPI | 1609689058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65731) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 20380) |
| Enumeration Date | 2025-01-29 |
| Last Update Date | 2025-06-18 |