| NPI | 1205232360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 11218) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036600) |
| 225100000X Physical Therapist (Licence: TX 1250571) | |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2014-11-17 |