| NPI | 1184657462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 9564) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 5338594-2401) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2008-05-13 |