| NPI | 1972571164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 5187) |
| Additional Taxonomies | 2251N0400X Physical Therapist Neurology (Licence: CO 5187) |
| 2251X0800X Physical Therapist Orthopedic (Licence: CO 5187) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2007-11-12 |