| NPI | 1659563278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 7951) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WA 10273) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: OR 5330) | |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2012-12-27 |