| NPI | 1457580987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY 1273) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 2871) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2009-07-07 |