| NPI | 1396978672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0010559) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60099260) |
| 251E00000X Home Health (Licence: CO PTL.0010559) | |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2022-08-23 |