| NPI | 1255677647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0012573) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 035329-1) |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2021-05-11 |