| NPI | 1215976469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 1997) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 11662) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2014-10-21 |