| NPI | 1265802763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO PTL.0013325) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 43137) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2022-03-08 |