| NPI | 1316248529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 2283) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 2283) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2013-02-25 |