| NPI | 1083678106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-03608) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT-1092) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2016-04-27 |