| NPI | 1013398247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0013234) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WY 1575) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2023-05-25 |