| NPI | 1457465007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY PT-0533) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY 533) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2013-05-02 |