| NPI | 1851977003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 20811) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046736-01) |
| 225100000X Physical Therapist (Licence: NH EL10788) | |
| 225100000X Physical Therapist (Licence: NV 6489) | |
| Enumeration Date | 2021-03-18 |
| Last Update Date | 2025-09-25 |