| NPI | 1023440468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3267) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 10996) |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2015-10-21 |