| NPI | 1831865914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019634) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: MO 2021024889) |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2024-07-03 |