| NPI | 1083676589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 0461) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 003284) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2017-12-06 |