| NPI | 1922493055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO ptl0012394) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2025-02-16 |