| NPI | 1548469984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 5729) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 4677) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2009-06-04 |