| NPI | 1700147006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 11688) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: CO 1081) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2012-06-04 |