| NPI | 1861897860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0013040) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1214402) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: KS 11-04959) | |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2014-12-12 |