| NPI | 1912185877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 5457) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NE 1096) |
| Enumeration Date | 2008-02-03 |
| Last Update Date | 2022-10-28 |