| NPI | 1760192629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0021422) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-034501) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-12-01 |
| Last Update Date | 2026-08-06 |