| NPI | 1003068438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 1899) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 16683) |
| 225100000X Physical Therapist (Licence: NY 003790-1) | |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2008-10-16 |