| NPI | 1962730663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 10275) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05010220A) |
| Enumeration Date | 2009-11-18 |
| Last Update Date | 2010-09-04 |