| NPI | 1710911250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 8909) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2022-09-28 |