| NPI | 1245538644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 11060) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019714) |
| 225100000X Physical Therapist (Licence: AZ 8256) | |
| 225100000X Physical Therapist (Licence: NY 029490) | |
| 225100000X Physical Therapist (Licence: CA PT36044) | |
| Enumeration Date | 2011-03-09 |
| Last Update Date | 2011-03-09 |