| NPI | 1770728867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 10187) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070016031) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2008-12-03 |