| NPI | 1518255975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0011123) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: CO 0011123) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CO 0011123) | |
| 2251E1200X Physical Therapist, Ergonomics (Licence: CO 0011123) | |
| 2251C2600X Physical Therapist, Cardiopulmonary (Licence: CO 0011123) | |
| 2251G0304X Physical Therapist, Geriatrics (Licence: CO 0011123) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2023-12-23 |