| NPI | 1295147148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3249) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 10924) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2015-12-22 |