| NPI | 1902566599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 32223) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP054235T) |
| Enumeration Date | 2021-12-22 |
| Last Update Date | 2026-04-03 |