| NPI | 1134287642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY pt1146) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WY PT1146) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2009-02-17 |