| NPI | 1114906930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 3316) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID RPT754) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2015-03-27 |