| NPI | 1023222429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 4407) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 066597) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2007-07-08 |