| NPI | 1942938352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020497) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 26357) |
| Enumeration Date | 2022-08-12 |
| Last Update Date | 2025-08-05 |