| NPI | 1073124277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO PTL.0017256) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2025-04-30 |