| NPI | 1891927349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 11420) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NC 12253) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2011-10-04 |