| NPI | 1205102605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 11601) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 00000) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2012-04-06 |