| NPI | 1801837521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 3988) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 10565) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2011-11-04 |