| NPI | 1124336011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 106433-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT-0497) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2010-09-14 |