| NPI | 1114223815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0011069) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: CO PTL.0011069) |
| Enumeration Date | 2011-01-28 |
| Last Update Date | 2023-11-03 |