| NPI | 1497835326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 8452) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WY PT-1121) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2007-11-29 |