| NPI | 1174626584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 10630) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 115363) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2010-09-09 |