| NPI | 1336171438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO PTL0009482) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT28978) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2020-04-07 |