| NPI | 1871247346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020207) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 6080) |
| Enumeration Date | 2022-02-03 |
| Last Update Date | 2025-06-19 |