| NPI | 1578641700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 7950) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 7950) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2022-01-28 |