| NPI | 1548732597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: CO PTL.0016145) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0016145) |
| Enumeration Date | 2018-12-31 |
| Last Update Date | 2020-01-17 |