| NPI | 1235543752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 0012763) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-04838) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2016-10-30 |