| NPI | 1588741672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 9310) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1172840) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-07-25 |