| NPI | 1043408214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT2170) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0011151) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2015-08-22 |