| NPI | 1700281771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 20718) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21194) |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2025-07-10 |