| NPI | 1104301704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0015377) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO PTL.0015377) |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2024-10-31 |