| NPI | 1609071174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 1336) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 3389) |
| 225100000X Physical Therapist (Licence: AZ 7214) | |
| 225100000X Physical Therapist (Licence: CO 3890) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2008-08-04 |