| NPI | 1598955759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0011034) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 005825) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2013-03-05 |