| NPI | 1932429511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0020578) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1198516) |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2025-06-18 |