| NPI | 1124177126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT2680) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 10535) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2013-07-18 |