| NPI | 1144291394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 010883) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 01881) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2019-10-15 |