| NPI | 1982494290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020792) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTLP.0000385) |
| Enumeration Date | 2025-05-09 |
| Last Update Date | 2025-11-21 |