| NPI | 1194734541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 5167) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 5167) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2020-04-03 |