| NPI | 1174770994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-008270) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2024-08-23 |