| NPI | 1730203241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 10662) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 9507) |
| 225100000X Physical Therapist (Licence: HI 2628) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2025-07-21 |