| NPI | 1679656185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: CO 7984) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 7984) |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2023-09-13 |