| NPI | 1164851267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 11636) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 6855586-2401) |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2015-07-21 |