| NPI | 1073757035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: CO 3580) |
| Additional Taxonomies | 225700000X Massage Therapist |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2009-04-21 |