| NPI | 1063675304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 11446) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 70303922401) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2018-04-20 |