| NPI | 1932333580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PT00011207) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2020-10-01 |