| NPI | 1073694097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0006769) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: CO PTL.0006769) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2017-11-10 |