| NPI | 1063182210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO PLT.0018490) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 300996) |
| Enumeration Date | 2021-09-19 |
| Last Update Date | 2022-12-21 |