| NPI | 1093076986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 11698) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 8247259-2401) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2012-06-06 |