| NPI | 1356709158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 20078) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: MD 25858) | |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2025-05-08 |