| NPI | 1982550448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020189) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT44509) |
| Enumeration Date | 2026-03-07 |
| Last Update Date | 2026-03-27 |