| NPI | 1891559639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019608) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CO AT.0002659) |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2024-02-12 |