| NPI | 1255616967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL-11450) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0011450) |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2023-10-24 |