| NPI | 1215950027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 23543) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 1484) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2016-06-03 |