| NPI | 1265787634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 9858) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251S0007X Physical Therapist, Sports | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2012-07-20 |