| NPI | 1730499534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0011410) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT25895) |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2025-08-19 |