| NPI | 1033459839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL0011903) |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2013-02-15 |