| NPI | 1164692117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-013099) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 62-028287) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2020-01-10 |