| NPI | 1205851920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 7570) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 7570) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2015-10-29 |