| NPI | 1760647333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 10597) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT34689) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2019-11-22 |