| NPI | 1063537843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 0274) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 6496) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2009-11-17 |