| NPI | 1982861183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 9981) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5695) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2011-09-22 |