| NPI | 1619182623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 10306) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 20909) |
| 225100000X Physical Therapist (Licence: NY 024655) | |
| 225100000X Physical Therapist (Licence: NC 9185) | |
| Enumeration Date | 2007-05-12 |
| Last Update Date | 2012-08-21 |