| NPI | 1871920843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO PTL.0014680) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MD 24553) |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2021-05-24 |