| NPI | 1942441530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020213) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1146221) |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2025-11-19 |