| NPI | 1730042607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0021138) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1407549) |
| Enumeration Date | 2025-12-06 |
| Last Update Date | 2026-05-27 |