| NPI | 1902968274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 2548) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 8681) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2007-07-08 |