| NPI | 1629808118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: CO 0020061) | |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2026-01-15 |