| NPI | 1578544706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 7875) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY 929) |
| Enumeration Date | 2005-11-05 |
| Last Update Date | 2011-03-09 |