| NPI | 1861490112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 2702) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0002702) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2022-01-05 |