| NPI | 1437332764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CO 6917) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 6917) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2007-12-10 |