| NPI | 1174844039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 9220) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT14281) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2018-03-15 |