| NPI | 1760857551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: CO OT.0007097) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO 2000025312) |
| Enumeration Date | 2015-12-06 |
| Last Update Date | 2024-01-22 |