| NPI | 1730868399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO CP035338T) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT40275) |
| Enumeration Date | 2023-07-12 |
| Last Update Date | 2024-10-25 |