| NPI | 1689220147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020267) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT4538) |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2026-05-19 |