| NPI | 1992137251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0015286) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 10466) |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2026-07-02 |