| NPI | 1073578290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3236) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT-942) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2015-01-20 |