| NPI | 1679953780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 20742) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2015027142) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2025-09-24 |