| NPI | 1154700342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 30684) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 61039) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2022-04-19 |