| NPI | 1790510147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 21297) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02287400) |
| Enumeration Date | 2024-09-05 |
| Last Update Date | 2026-05-27 |