| NPI | 1295009942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: CO PTL-11118) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 5119) |
| Enumeration Date | 2012-02-28 |
| Last Update Date | 2012-02-28 |