| NPI | 1770660110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO PTL.0013017) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-03651) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-12-28 |