| NPI | 1417029083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 9586) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1043339) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2013-01-11 |