| NPI | 1750612636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 10613) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CT 14520) |
| Enumeration Date | 2010-01-17 |
| Last Update Date | 2025-03-18 |