| NPI | 1538384847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY PT-1202) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 1519) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2015-02-04 |