| NPI | 1619715869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 21067) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD CP049847T) |
| 225100000X Physical Therapist (Licence: SC 12439) | |
| 225100000X Physical Therapist (Licence: DE J1-0014906) | |
| Enumeration Date | 2024-07-19 |
| Last Update Date | 2026-01-27 |