| NPI | 1235114141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ LPT30026) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT27275) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2018-06-20 |