| NPI | 1710059936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 134209263) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 134209263) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2012-05-04 |