| NPI | 1073961140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 12225) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: AZ 12225) |
| 2251X0800X Physical Therapist Orthopedic (Licence: AZ 12225) | |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2016-05-31 |