| NPI | 1912556416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0020479) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 0020479) |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2026-05-18 |