| NPI | 1013411545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0016769) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CO PTL.0016769) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2021-08-31 |