| NPI | 1033325915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 1712) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 1712) |
| 2251S0007X Physical Therapist, Sports (Licence: AZ 1712) | |
| 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: AZ 1712) | |
| 2251G0304X Physical Therapist, Geriatrics (Licence: AZ 1712) | |
| 2251C2600X Physical Therapist, Cardiopulmonary (Licence: AZ 1712) | |
| 2251P0200X Physical Therapist, Pediatrics (Licence: AZ 1712) | |
| 2251N0400X Physical Therapist, Neurology (Licence: AZ 1712) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2012-12-04 |