| NPI | 1730954868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020214) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 051678) |
| Enumeration Date | 2023-11-20 |
| Last Update Date | 2026-02-20 |