| NPI | 1104080118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 5294) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 5294) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2021-03-27 |