| NPI | 1205206430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 32111) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 43149) |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2022-02-23 |