| NPI | 1013087543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 7198) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT871109) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2017-02-27 |