| NPI | 1164837290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-30633) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208739) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2019-04-25 |