| NPI | 1609142991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 11580) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 25852) |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2012-03-30 |