| NPI | 1376912238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 15295) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 038707-1) |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2023-11-15 |