| NPI | 1275581480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-012353) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA pt16623) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2024-10-14 |