| NPI | 1922255173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL-10139) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 10139) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2021-05-09 |