| NPI | 1902273733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0013308) |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2020-11-05 |