| NPI | 1801287925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0009626) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MA 21479) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CO PTL.0013079) | |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2026-03-09 |