| NPI | 1568640951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 9219) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL pth4580) |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2008-02-07 |