| NPI | 1942731708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0014506) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: CO PTL.0014506) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2022-10-11 |