| NPI | 1265085476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: AZ 30753) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 30753) |
| 2251E1200X Physical Therapist Ergonomics (Licence: AZ 30753) | |
| 2251G0304X Physical Therapist Geriatrics (Licence: AZ 30753) | |
| 2251S0007X Physical Therapist Sports (Licence: AZ 30753) | |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2019-07-17 |