| NPI | 1023012887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 10803) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 016280) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2022-08-08 |