| NPI | 1043796261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: CO CP028239T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 14358-24) |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2024-03-26 |