| NPI | 1235534827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 12343) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 41800) |
| Enumeration Date | 2014-10-26 |
| Last Update Date | 2017-05-09 |