| NPI | 1821493628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 12916) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 12961) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2016-07-20 |