| NPI | 1245463967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 9102) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-009435) |
| 225100000X Physical Therapist (Licence: MI 5501008782) | |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2009-08-27 |