| NPI | 1770326860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP048718T) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: CO PTL.0019957) | |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2025-09-02 |