| NPI | 1992428783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0021416) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: FL PT39446) | |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2026-07-15 |