| NPI | 1255728309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0012898) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: CO PTL.0012898) |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2023-08-07 |